Introduction to Treatment

Schroth Therapy

Schroth treatment is based upon some simple principles originally created by Katharina Schroth of Germany in 1921.

Her daughter Christa settled in Bad Sobernheim in Germany continued on her work and a clinic ‘Katharina Schroth Klinik’ was opened in 1983. A physiotherapist, Katharina was awarded the federal cross of merit for the success of her concept. It became and still is the most recognised conservative exercised-based approach.

There are several sub sections within the original Schroth treatment; postural adaptation in regular activities Schroth specific exercises including rotational breathing and physiologic exercises.

What is the Schroth Best Practice method compared with Original German Schroth method?

Original German Schroth exercise method was developed in the 1920’s in Germany by a physiotherapist (Katharina Schroth – grandmother of Dr Weiss) to reduce pain and prevent spinal curve progression. Schroth alone without bracing in the growing patient is not sufficient unless the patient has less than 25 degrees. This is because the spine cannot maintain the load in the over-corrected positions consistently without a modern rigid brace in position. But if the condition is treated with Schroth therapy early, in these small curve cases it is effective enough alone along with close monitoring, but usually, especially in the UK the smaller curves grow without detection due to lack of screening.

The original German method is well-established as a three-dimensional approach to change the shape of the muscles – activate the over-long muscles in a short position and the short muscles in a stretched position. Incorporating rotational breathing to assist to reduce ribcage deformity. Original German Schroth is more directed at larger stiffer and kyphotic adult curves and is effective at reducing pain and improving aesthetics – the look of the spine. It is still used for adult patients, unbraced patients and those weaning from bracing to stabilise the spine and address pain related to posture.

Schroth Best Practice method incorporates the original principles of Katharina Schroth Method. More modern Best Practice Schroth, however is more appropriate for the younger braced adolescent idiopathic scoliosis, providing the most effective loading through postural overcorrection and specific efficient exercises for younger patient exercise regimes. It not only aims at muscle lengths and aesthetics, it complements the brace design by improving flexibility and therefore the correction and comfort in the initial brace fittings. These Best Practice exercises are less enduring and simpler in set-up for the braced younger patients to manage and allow them to live their life without suffering lengthy exercise regimes. PSSE (Physiotherapeutic Specific Scoliosis Exercises) has an evidence base with four Randomised Controlled trial’s (RCT’s) supporting this type of specific exercise treatment and PSSR (Pattern Specific Scoliosis Exercises), which relate to the original principles of Lehnert Schroth have shown to be the most effective in an RCT for this patient group.

Four weeks of intensive treatment is just not possible for most young patients and is not generally necessary as these simpler exercises can be carried out with self-management. If you can train them on how to be over-corrected – not straight, then when gravity s working on them, the condition is prevented from worsening. By the mechanism of unloading the growth plates and improving the overall muscle imbalance the brace combined with the exercises will improve the cobb angle and boney deformity in the growing patient group.

This new Schroth Best Practice approach, does not abandon the original, but recognises that in some circumstances the original was not addressing adolsecent presentation effectively which has changed since the 1920’s. Understanding when and which is the more appropriate type of treatment comes with experience using the different models. Bracing in the pre-pubescent patients is strongly recommended and provided within this new approach. German correction bracing – Gensingen is available in the UK. Adult Scoliosis Bracing – Physiologic Brace is also available in the UK – in adults is only appropriate when pain, aesthetics or stability issues occur.